Use of Intravenous tPA for the Management of Acute Ischemic Stroke in the Emergency Department
Publication Date: September 1, 2015
Last Updated: March 14, 2022
Recommendations
Patient Management
With a goal to improve functional outcomes, IV tPA should be offered and may be given to selected patients with acute ischemic stroke within 3 hours after symptom onset at institutions where systems are in place to safely administer the medication. The increased risk of symptomatic intracerebral hemorrhage (sICH) should be considered when deciding whether to administer IV tPA to patients with acute ischemic stroke. (B)
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When feasible, shared decisionmaking between the patient (and/or his or her surrogate) and a member of the health care team should include a discussion of potential benefits and harms prior to the decision whether to administer IV tPA for acute ischemic stroke. (C)
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When feasible, shared decisionmaking between the patient (and/or his or her surrogate) and a member of the health care team should include a discussion of potential benefits and harms prior to the decision whether to administer IV tPA for acute ischemic stroke. (C)
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Despite the known risk of sICH and the variability in the degree of benefit in functional outcomes, IV tPA may be offered and may be given to carefully selected patients with acute ischemic stroke within 3 to 4.5 hours after symptom onset at institutions where systems are in place to safely administer the medication. (B)
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Title
Use of Intravenous tPA for the Management of Acute Ischemic Stroke in the Emergency Department
Authoring Organization
American College of Emergency Physicians
Publication Month/Year
September 1, 2015
Last Updated Month/Year
July 31, 2023
External Publication Status
Published
Country of Publication
US
Document Objectives
This clinical policy from the American College of Emergency Physicians is the revision of a clinical policy approved in 2012 addressing critical questions in the evaluation and management of patients with acute ischemic stroke
Target Patient Population
Patients with acute ischemic stroke
Inclusion Criteria
Female, Male, Adolescent, Adult, Older adult
Health Care Settings
Emergency care
Intended Users
Paramedic emt, nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Management, Treatment
Diseases/Conditions (MeSH)
D020521 - Stroke, D002545 - Brain Ischemia, D010960 - Plasminogen Activators, D010959 - Tissue Plasminogen Activator
Keywords
Acute Ischemic Stroke, t-pa, plasminogen activator
Source Citation
Ann Emerg Med. 2015;66:322-333.
Methodology
Number of Source Documents
100
Literature Search Start Date
January 1, 2011
Literature Search End Date
September 3, 2014